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Ischemic Stroke
Original research
Prognosis of asymptomatic intracranial hemorrhage after endovascular treatment
  1. Yonggang Hao1,2,
  2. Wenhua Liu3,
  3. Huaiming Wang4,5,
  4. Wenjie Zi6,
  5. Dong Yang4,
  6. Wei Wang7,
  7. Xiguang Tian8,
  8. Fuqiang Guo9,
  9. Ping Jin10,
  10. Yunyun Xiong6,
  11. Xinfeng Liu1,4,6,
  12. Gelin Xu1,4,6
  1. 1 Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, China
  2. 2 Department of Neurology, Sir Run Run Shaw Hospital,School of Medicine, Zhejiang University, Hangzhou, China
  3. 3 Department of Neurology, Wuhan No 1 Hospital, Wuhan, China
  4. 4 Department of Neurology, Jinling Hospital, Second Military Medical University, Nanjing, China
  5. 5 Department of Neurology, 89th Hospital of People’s Liberation Army, Weifang, China
  6. 6 Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
  7. 7 Department of Radiology, Yangzhou No 1 People’s Hospital, Yangzhou University, Yangzhou, China
  8. 8 Department of Neurology, Chinese Armed Police Force Guangdong Armed Police Corps Hospital, Guangzhou, China
  9. 9 Department of Neurology, Sichuan Provincial People’s Hospital, Chengdu, China
  10. 10 Department of Neurology, Lu’an Affiliated Hospital of Anhui Medical University, Lu’an, China
  1. Correspondence to Professor Gelin Xu, Department of Neurology, Jingling Hospital, Southern Medical University, Nanjing, 210002, Jiangsu, China; gelinxu{at}nju.edu.cn

Abstract

Objective Asymptomatic intracranial hemorrhage (aSICH) is a common phenomenon after endovascular treatment of acute ischemic stroke, but its prognostic impacts remain unclear. This study evaluated functional outcomes of thrombectomy in patients with and without aSICH.

Methods Patients with acute ischemic stroke due to large artery occlusion in the anterior circulation who were treated with thrombectomy were enrolled in 21 centers. According to CT scans performed within 72 hours of endovascular procedures, patients with aSICH or without intracranial hemorrhage were included while patients with symptomatic intracranial hemorrhage (SICH) were excluded. Baseline data and functional outcomes were compared between patients with aSICH and those without intracranial hemorrhage. Logistic regression analysis was applied to evaluate the impacts of aSICH on functional outcomes.

Results Of the 632 patients with endovascular treatment, 101 (16.0%) were classified as having SICH, 212 (33.5%) as having aSICH, and 319 (50.5%) as being without intracranial hemorrhage. Patients with aSICH after endovascular treatment had a lower ratio of excellent outcome (mRS 0–1, OR 0.53; 95% CI 0.33 to 0.84, P=0.007) than those without intracranial hemorrhage. There were no significant differences concerning favorable outcome (mRS 0–2, OR 0.76; 95% CI 0.50 to 1.14, P=0.185) or mortality (OR 0.64; 95% CI 0.38 to 1.09, P=0.101) between patients with aSICH and those without intracranial hemorrhage.

Conclusions In an Asian population, aSICH after thrombectomy may decrease the likelihood of an excellent functional outcome but does not influence a favorable outcome and mortality in patients with ischemic stroke due to large artery occlusion in the anterior circulation.

  • stroke
  • thrombectomy
  • hemorrhage

https://doi.org/10.1136/neurintsurg-2018-013848

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    Footnotes

    • YH and WL contributed equally.

    • Contributors YH, WL: Drafting the work, revising it critically for important intellectual content and substantial contributions to the conception and design of the work; acquisition, analysis, and interpretation of data for the work. HW, WZ, DY, WW, XT, FG, PJ, YX: Substantial contributions to the conception and design of the work; acquisition, analysis, and interpretation of data for the work. XL: Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. GX: Final approval of the version to be published and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding This work was partly supported by National Natural Science Foundation of China (No. 81530038, 81220108008, 81400898, 81400993, 81571143 and 81671172), Jiangsu Provincial Special Program of Medical Science (No. BL2013025) and Chinese Postdoctoral Science Fund (No. 2015M572815).

    • Competing interests None declared.

    • Patient consent Parental/guardian consent obtained.

    • Ethics approval The study was approved by the local ethic committees of the included centers.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Collaborators ACTUAL investigators: Xinfeng Liu, Gelin Xu, Yunyun Xiong, Wenjie Zi, Dong Yang, Huaiming Wang, Yonggang Hao, Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Second Military Medical University, Southern Medical University, Nanjing, China; Meng Zhang, Chengchun Liu, Department of Neurology, Research Institute of Surgery, Daping Hospital, Third Military Medical University; Yu Geng, Zongjie Shi, Jinhua Zhang, Department of Neurology, Zhejiang Provincial People’s Hospital; Hang Lin, Min Lin, Zhen Hu, Department of Neurology, Fuzhou General Hospital of Nanjing Military Region; Xiaorong Deng, Yue Wan, Department of Neurology, Hubei Zhongshan Hospital; Jiandong Zhang, Zhonghua Shi, Mirui Qu, Department of Neurosurgery, the 101st Hospital of the People’s Liberation Army; Zhiming Zhou, Xianjun Huang, Department of Neurology, Yijishan Hospital of Wannan Medical College; Wei Wang, Department of Radiology, the First People’s Hospital of Yangzhou, Yangzhou University; Haowen Xu, Tao Quan, Sheng Guan, Department of Neurology, the First Affiliated Hospital of Zhengzhou University; Xiguang Tian, Lin Chen, Department of Neurology, the Chinese Armed Police Force Guangdong Armed Police Corps Hospital; Penghua Lv, Xiaobo Li, Department of Neurology, Northern Jiangsu People’s Hospital; Shuiping Wang, Shiquan Yang, Department of Neurology, the 123rd Hospital of the People’s Liberation Army; Wenhua Liu, Dan Wei, Department of Neurology, Wuhan No.1 Hospital; Zhen Wang, Department of Neurology, Changsha Central Hospital; Xintong Liu, Department of Neurology, Guangdong Provincial No.2 People’s Hospital; Fuqiang Guo, Shu Yang, Department of Neurology, Sichuan Provincial People’s Hospital; Dequan Zheng, Xinyu Wu, Youfu Zeng, Department of Neurology, the 175th Hospital of the People’s Liberation Army, the Affiliated Southeast Hospital of Xiamen University; Mingyi Tu, Department of Neurology, Hubei Wuchang Hospital; Ping Jin, Yong Liu, Department of Neurology, Lu’an Affiliated Hospital of Anhui Medical University; Hua Li, Jiayang Fang, Department of Neurology, 476th Hospital of the People’s Liberation Army; Guodong Xiao, Department of Neurology, the Second Affiliated Hospital of Soochow University.